Association Between Asymptomatic Proximal Deep Vein Thrombosis and Mortality in Acutely Ill Medical Patients
Key result
Asymptomatic proximal DVT is linked to ~131% higher all-cause mortality in acutely ill medical patients.
- HR 2.31
- 95% CI 1.52-3.51
- P<0.0001
- n=7,036
Why the study?
Asymptomatic proximal DVT is frequently used to evaluate anticoagulant thromboprophylaxis efficacy in medical patients, but its clinical relevance has recently been challenged.
Does asymptomatic proximal DVT increase all-cause mortality in acutely ill medical patients?
Population
7036 acutely ill medical patients receiving thromboprophylaxis with adequate leg compression ultrasound
Comparison
Asymptomatic proximal DVT vs symptomatic DVT vs no VTE
Design
Post hoc cohort analysis of a randomized trial
Authors
Discussion
Loading...
Member takes
Implication
Signals higher mortality risk in medical inpatients; supports asymptomatic proximal DVT as endpoint in thromboprophylaxis trials.
Key Points
- To evaluate the relationship between asymptomatic proximal deep vein thrombosis and all-cause mortality in acutely ill medical patients.
- Analyzed 7,036 acutely ill medical patients from a randomized trial (NCT00571649) who received thromboprophylaxis and underwent leg compression ultrasound on day 10 or day 35.
- Categorized patients into no venous thromboembolism (VTE; n=6,776), asymptomatic proximal deep vein thrombosis (DVT; n=236), or symptomatic VTE (n=24), comparing all-cause mortality using adjusted Cox proportional hazards models.
- All-cause mortality occurred in 4.8% of patients without VTE compared to 11.4% of patients with asymptomatic proximal DVT (hazard ratio [HR], 2.31; 95% CI, 1.52–3.51; P < 0.0001).
- Symptomatic VTE was associated with a 29.2% mortality rate (HR, 9.42; 95% CI, 4.18–21.20; P < 0.0001) relative to patients without VTE.
Study Design
Type
Cohort (n=7,036)
Structured PICO
Does asymptomatic proximal DVT increase all-cause mortality in acutely ill medical patients?
P
Population
7,036 acutely ill medical patients who received at least 1 dose of study drug for VTE prevention and had an adequate compression ultrasound examination of the legs on either day 10 or day 35
I
Intervention
Presence of asymptomatic proximal deep vein thrombosis (DVT)
C
Comparator
No venous thromboembolism (VTE)
O
Outcome
All-cause mortality (ACM)hard clinical
Main Result
Effect estimate: HR 2.31 (95% CI 1.52-3.51)
Absolute Event Rate: 11.4% vs 4.8%
p-value: p=<0.0001
Asymptomatic proximal DVT is independently associated with increased all-cause mortality in acutely ill medical patients, validating its use as a clinical endpoint in thromboprophylaxis trials.
Limitations
- The analysis was post hoc
- Ultrasound results were not available for all patients
- Adjustment for baseline variables significantly associated with ACM may not fully compensate for differences
- post hoc analysis
- ultrasound results were not available for all patients
- adjustment for baseline variables may not fully compensate for differences
Cite This Study
Raskob et al. (2021) conducted a cohort in Acutely ill medical patients (n=7,036). Asymptomatic proximal DVT vs. No VTE was evaluated on All-cause mortality (HR 2.31, 95% CI 1.52-3.51, p=<0.0001). Asymptomatic proximal DVT in acutely ill medical patients was associated with significantly higher all-cause mortality compared to no VTE (11.4% vs 4.8%; HR 2.31; 95% CI 1.52-3.51; P<0.0001).